Related Experiment Videos
Ultra-early rebleeding within six hours after aneurysmal rupture
1Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
Surgical Neurology
|August 1, 1994
Summary
Delaying cerebral angiography in patients with subarachnoid hemorrhage significantly reduced ultra-early rebleeding rates. Withholding invasive procedures within 6 hours of rupture is effective in preventing rebleeding events.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Early operation for ruptured aneurysms was prioritized using immediate cerebral angiography.
- This approach led to a two-fold higher incidence of rebleeding during angiography within 6 hours post-rupture.
Purpose of the Study:
- To evaluate the effectiveness of withholding angiography in the ultra-early stage (within 6 hours) after subarachnoid hemorrhage.
- To assess the impact of this policy change on ultra-early rebleeding rates.
Main Methods:
- A comparative study of patients admitted between 1980-1985 and 1986-1992.
- Analysis of rebleeding rates and timing of cerebral angiography in relation to subarachnoid hemorrhage onset.
Main Results:
- The percentage of patients undergoing angiography within 6 hours decreased from 45% to 13% (p < 0.01).
- Ultra-early rebleeding rates decreased from 15% to 5% (p < 0.01).
- Despite reduced rebleeding, an increase in rebleeding during transfer was noted with more ultra-early referrals.
Conclusions:
- Withholding aggressive management like angiography in the initial 6 hours post-subarachnoid hemorrhage is effective in reducing ultra-early rebleeding.
- Delaying patient transfer and interventions until after 6 hours is recommended unless an emergency operation is immediately required.